Provider Demographics
NPI:1558965053
Name:MONTENEGRO, ANNABEL DELCARMEN (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:ANNABEL
Middle Name:DELCARMEN
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26831 S TAMIAMI TRL UNIT 48
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7828
Mailing Address - Country:US
Mailing Address - Phone:239-948-3200
Mailing Address - Fax:
Practice Address - Street 1:26831 S TAMIAMI TRL UNIT 48
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7828
Practice Address - Country:US
Practice Address - Phone:239-948-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH19575124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist